Preparing For Notification

An organized approach is essential (T.a.bleā€ž ā€ž2.8.6Z1). A secluded area close to the ED is available for the family and friends. This area includes a telephone to allow the contact of relatives, friends, and other supporters. Ideally, a member of the clergy or a social worker is present during the discussions. If the family arrives while resuscitation efforts are continuing, a physician or trained member of the hospital staff informs them of the resuscitation and its progress. Updates are given frequently (every 5 to 10 min) until the effort concludes.10 Sharing information and empathy during this time allows family members to become knowledgeably prepared for the potential outcome.

TABLE 286-1 Sequence of Events

The emergency physician must prepare prior to speaking with the family. After leaving the resuscitation room, the physician must mentally "change gears" over 15 to 30 s. Knowing what to do and what to anticipate can be reassuring. A calm demeanor is essential for effective communication with the family. It is important to collect one's thoughts and organize the presentation. If clothing is soiled, it is changed before the notification. An appropriate amount of time is allotted. Other tasks in the department are delegated to others, or families are informed of the reason for delay. Advance information about which family members are present and their preparation is obtained when possible. This information can be gathered from the clergy, nurse, or physician who has served as intermediary. It is best not to go alone. If clergy or social services support is not yet present, or will not be available in a timely fashion, nursing staff can be enlisted.

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